title: Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical residents.
abstract: OBJECTIVE
  Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents.
  
  
  BACKGROUND
  Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers.
  
  
  METHODS
  Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database.
  
  
  RESULTS
  The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge.
  
  
  CONCLUSIONS
  A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.
authors.affiliation: Department of Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia (Drs Wolk, Adams, Moore, and Jaipaul); Georgetown University School of Medicine, Washington, District of Columbia (Mr Wang); School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia (Drs Horak and Cloonan and Ms Brown, Deluca, and Grossman); and University of Virginia, Charlottesville (Mr Dasgupta).
authors.forename: Adam
authors.initials: A
authors.lastname: Wolk
authors.forename: Erwin
authors.initials: E
authors.lastname: Wang
authors.forename: Bernard
authors.initials: B
authors.lastname: Horak
authors.forename: Patricia
authors.initials: P
authors.lastname: Cloonan
authors.forename: Michael
authors.initials: M
authors.lastname: Adams
authors.forename: Eileen
authors.initials: E
authors.lastname: Moore
authors.forename: Chitra Komal
authors.initials: CK
authors.lastname: Jaipaul
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Brown
authors.forename: Dabanjan
authors.initials: D
authors.lastname: Dasgupta
authors.forename: Danielle
authors.initials: D
authors.lastname: Deluca
authors.forename: Mila
authors.initials: M
authors.lastname: Grossman
mesh_terms: D002983:Clinical Competence; D020445:Hospitalists / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards*; D007396:Internship and Residency / Q000592:standards*; D008505:Medical Staff, Hospital / Q000592:standards*; D063886:Patient Discharge Summaries / Q000592:standards*; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D013997:Time Factors